Pyelonephritis in children
The content of the article:
Pyelonephritis in children is the affection of parenchyma, interstitium, tubules, cups and pelvis of the kidneys, which bears non-specific microbial-inflammatory in nature.
Pyelonephritis in children is widespread and often the disease is diagnosed only SARS. Between these diseases there is a direct relationship. Urologists indicate that one in four children sick with pyelonephritis before that had a viral respiratory infection and kidney inflammation was a complication of the infection.
According to statistics, the maximum number of cases of pyelonephritis in children have not reached school age. 3 times more often than acute disease affects girls than boys, because of the peculiarities of the structure of their urogenital system, short and narrow urethra.
The symptoms of pyelonephritis in children
Experts distinguish two forms of pyelonephritis that can occur in childhood: primary and secondary disease:
Primary is considered the pyelonephritis that develops without the any predisposing factors, i.e. the microbial-inflammatory process manifests in a healthy body. This happens rarely, no more than 10% of cases.
The secondary pyelonephritis occurs for specific reasons. It can be with obstruction and without it. Obstruction may be due to not only a mechanical obstacle to the current of urine, but can also result from functional disorders.
With regard to acute and chronic pyelonephritis in children, the duration of the existing pathological process and symptoms, which gives the disease.
The symptoms of pyelonephritis in children during acute illness, the following:
- Start of acute with fever remitting disseminated type. That is, the temperature rise is significant, in the morning period value rises above 37 degrees, in the evening it may rise one or two degrees.
- The baby is sweating, it feels cold.
- There are headaches, weakness, anorexia.
- Infantsobserved persistent vomiting, stool softener, vomiting, weight loss.
- If the inflammatory process involved the lower parts of the urinary system, the child arise dizuricheskie disorder. Children experience frequent urination during this process are concerned, may complain of burning sensation while emptying the bladder or suffer from incontinence.
- Abdominal pain have no clear localization. Lower back pain can occur intermittently, worse during tapping or after exercise.
Chronic disease usually not accompanied by acute symptoms, they are often scarce. For such children and is characterized by fatigue, asthenia, skin is often pale.
Often there is a hidden form of chronic process to identify which possible only by urinalysis results. Such children are more often behind in school curricula, show low academic performance, excessively irritable, etc.
Causes of pyelonephritis in children
Pathogenic agent which could lead to the development of the disease in children is most often Escherichia coli. However, sometimes provoke inflammation may Pseudomonas aeruginosa, Proteus, Staphylococcus, representatives of enterococci, Mycoplasma, chlamydia, etc. to the spread of bacteria that get into the urinary tract can be the vagina, large intestine, the cavity of the foreskin.
Possible ways of penetration of microorganisms in the kidneys:
- Hematogenous route of infection, that is, by the bloodstream. Such skid of pathogens is prevalent in young age, children under one year. Risks increase in the presence of purulent omphalitis of newborn with angina, pneumonia, pustular skin lesions.
- Lymphogenous way of infection through the lymphatic ducts.
- Urinogenous way route of infection. The upward drift of the bacteria characteristic for children is more senior year. The risk increases when intestinal infections, dysbacteriosis, colitis, vulvitis and vulvovaginitis in girls, balanopostita boys, cystitis, etc.
Pyelonephritis occurs in children under the influence of a number of factors provocateurs, including:
- Anomalies of the urinary system, impeding the passage of urine;
- Neurogenic bladder;
- Vesicoureteral reflux;
- Excess vitamin D in the body;
- Malnutrition fromchildren;
- The lack, or violation of activity of any enzyme;
- Dysmetabolic nephropathy;
- Infection of worms;
- Infectious diseases: wind smallpox, SARS, scarlet fever, measles, mumps, etc.;
- Any factors having a dampening effect on the immune system.
Almost all children who have ill with pyelonephritis in age from one month to three years is characterized by frequent viral respiratory infections, atopic dermatitis and intestinal dysbiosis.
Diagnosis of pyelonephritis in children
Pyelonephritis most often exhibit laboratory evidence. Often the child's complaints are rather sparse or may be absent altogether due to the age of the child or by reason of a latent flow. Collecting the anamnesis begins with an explanation of patient complaints, specified symptoms such as: increased body temperature without the background of catarrhal phenomena, violation of the process of urination, pain in the side.
Often, on palpation of the abdomen in the course of the ureters child complains of pain, unpleasant sensations arise when effleurage in the costovertebral angle. However, even if the fact that the symptoms and the results of the inspection indicate pyelonephritis, your doctor can't make a definitive diagnosis without performing laboratory tests.
So, diagnosis of pyelonephritis in children involves the following studies:
- Performing clinical analysis of blood;
- Performing biochemical analysis of blood;
- Implementation of the common urine test;
- Determination of pH of urine;
- Fence quantitative sampling: to zimnitsky, Nechyporenko, Addis-Chukovskomu, Hamburge;
- Urine culture with antibiogram implementation;
- Performing biochemical analysis of urine.
- Performing ultrasound of the kidneys and indications for ultrasound of the bladder;
- Performing excretory urography;
- Doppler ultrasound of renal blood flow;
- Conduct urodynamic studies;
- Performing renal angiography at the testimony;
- Performing a CT scan of the kidneys, on the testimony;
- Performing dynamic renal scintigraphy indicated.
Be sure to check urine output, and examine the rate and volume of spontaneous urination.
Indicators of urine in pyelonephritis
The presence of the disease is indicated by the following data of laboratory examination of urine:
- Bacteriuria in the number of microbial bodies in excess of 100 000/1 ml;
- Proteinuria at rates less than 1G/l;
- The increase in the number of neutrophils more than 50%;
- Reduced osmolarity of urine (less than 800 mOsm/l), reducing its density;
Combined with the symptoms of intoxication and with pain symptom, these data indicate pyelonephritis in children.
Treatment of pyelonephritis in children
Treatment of pyelonephritis in children involves the use of antibiotics, which must be supplemented by symptomatic and pathogenetic therapy. An equally important regimen of eating and drinking of the child.
About whether to hospitalize the patient or not, the decision is made by the doctor, it will depend on the condition of the patient, from the possible risk of complications, in what social conditions the child lives. Bed rest is necessary to adhere at least 5 days and when fever and severe pain, it increases by 2 days.
Diet is a mandatory condition of recovery. It allows you to reduce the load on the diseased organs and to correct the existing metabolic disorders. During acute illness the recommended table№5 by Pevsner. While drinking regime should be increased by 50% from age norm of a child. The amount of salt is limited only when kidney failure. Protein and vegetable food must alternate, banned all products containing essential oils. Eliminated the use of fried, spicy and oily food.
Antibiotic treatment of children is based on the following points:
- Before starting therapy you should perform a urine culture and subsequently received the results to adjust the therapy;
- All factors provocateurs, influencing the disease need to be addressed;
- Improve the health of a child is not evidence that he had bacteriuria;
- Conclusion the effectiveness of the treatment can be done in the absence or presence of bacteriuria;
- If the disease is primary and has affected the lower urinary tract, it is enoughsometimes a short course of antibiotics, if the process involved the upper urinary tract, then therapy should be prolonged;
- If after 2 weeks there is a relapse, this indicates that the bacteria were not entirely destroyed. If relapse occurs late, the disease caused by re-infection;
- If the infection is community-acquired, it most often responds well to treatment with antibacterial drugs;
The stages of treatment of pyelonephritis in children:
- Suppress the activity of the inflammatory process.
- To conduct pathogenetic treatment aimed at correction of immunity;
- Implementation of prevention aimed at preventing the recurrence of the disease. Often required to get rid of the child from chronic infection.
Initial antibiotic therapy is selected empirically, i.e., based on its experience of treatment of pyelonephritis in children. Most often the drugs of choice are: Amoxiclav, Augmentin, Cefuroxime (Ketocef, Zinacef), Cefamandol, Cefotaxime, Ceftazidime, Apocaly, Cefobid, Ceftriaxone, Gentamicin, Amicin, Likacin.
For the complete suppression of the causative agent of a disease subject to treatment in hospital, you will need a 4 week course of antibiotics with them changing every week or 10 days. Intramuscular and intravenous preparations are administered only in the acute phase, then transferred to oral.
When treatment with antibiotics fails, the child necessary to continue therapy uroantiseptiki: Furadonin, Blacks, Nevigramon.
In the beginning of the disease prescribed diuretics – Veroshpiron, Furosemide. To enhance the effect of antibiotic therapy, prescribed NSAIDs – Ortofen, Surgam, Voltaren.
Drugs with antioxidant activity, prescribed to children with pyelonephritis: Tocopherol acetate, UNITA, b-carotene.
To eliminate allergic reactions use Tavegil, Suprastin, claritin.
Prevention of pyelonephritis in children
The primary prevention of pyelonephritis in children include:
- Avoidance of urinary retention in the bladder, regular emptying.
- Regular emptying of the bowel.
- The maintenance of adequate age drinking regime.
- Prevention of dysbiosis.
- Perform all preventive vaccinations.
- Proper hygiene of the external genitalia in girls and boys.
- Timely treatmentinflammatory diseases of the genitourinary system.
- Ultrasonography of the kidneys and bladder of children under one year, which allows timely detection of anomalies of development.
If the child at least once suffered a pyelonephritis, he will have to undergo medical follow-up by a nephrologist. With regard to the children take off in the absence of recurrence of the disease for three years.
As a rule, acute pyelonephritis in childhood in 80% of cases ends favorably, and the child recovers completely. The development of complications or fatal outcome is the exception from the General pediatric and urological practice. First of all it concerns impaired children with severe concomitant pathologies.